Tuesday, July 10, 2012

Goldman is a nationally-recognized health economist influential in both academic and policy circles. He is the author of more than 100 articles and book chapters, including articles in some of the most prestigious medical, economic, health policy, and statistics journals. He is a health policy advisor to the Congressional Budget Office, and is a frequent speaker on healthcare issues. He joins us July 12 at UCLA for “California: Uniting Science and Policy to Advance Cancer Care.” It’s not too late to register for the event – contact Marisa Reinoso at reinoso@chi.org.

Q: What policies have greatly impacted cancer care in your opinion?

A: I think what people don’t realize is just how important reimbursement and other health policies are in terms of changing the way treatment gets delivered. For example, if you look at the rules for Medicare reimbursement, most of the reimbursement has been generous, historically, for infused therapies. And the result is that we have many infused therapies for cancer. And the question is whether that generous reimbursement is going to continue. Even more important is the relationship between reimbursement and future innovation.

The idea is that we have the luxury in the United States because we have reimbursed, historically, at generous levels that, for our conditions, we’ve actually made progress. We’re actually winning the war on cancer and we’re doing it through treatment, as well as diagnosis. The issue is whether that type of progress will continue.

Q: You talk a lot about the importance, both from a health standpoint and an economic one, of prevention and preventive care. How much of this will rely on medical diagnostics and advanced technologies and how much is it reliant on an individual to change his or her behavior?

A: What we found is the change in behavior is notoriously difficult. If you roll the clock back 50 years and you think about hypertension, it has always been a serious health dilemma in this country. But we know there are behavioral modifications that will help people – they can change their diet, reduce their salt intake and exercise more. But what we found is that very few people comply.

Actually, the introduction of drugs, mainly beta blockers, diuretics, calcium channel blockers, and a whole host of therapies, have actually resulted in incredible improvements in cardiovascular-related mortality in the United States. These classes of drugs have been a huge success and they have been able to substitute where previously we had to rely on behavioral change. There is an important lesson here. Yes, we’d like to modify behavior. And, yes, behavior change has value. But it is also important that we continue to innovate to find ways where biomedicine can fill those gaps.

Q: How do you see California leading the way in terms of healthcare following the Affordable Care Act, with so many uninsured?

A: As in so many areas, California is one of those states that defines the way other states will react to policies. As you know, we face a severe fiscal and economic crisis in the state. It is easy to say one of the reasons for this is healthcare, so we should be working hard to reduce reimbursement in many areas. But it is important to realize that California is also the engine for biotechnology and biomedicine is one of the engines of growth in this state.

California has a reasonably competitive health insurance market. In the private sector, they have been initiating reforms that will drive reimbursement down where it needs to be driven down. And it will drive up where we need to reward value. We should be careful to make sure that we encourage those markets to work as efficiently as possible. And that may mean even raising reimbursement in some areas.

Q: What’s been consuming the majority of your time these days?

A: I have been spending my time trying to think about other ways that we can 1) reimburse high-value therapy and 2) come up with better models to try and understand the short- and long-implications of disease. For example, if you think about a country’s progress generally, and we tend to look at gross national product or gross domestic product, but we don’t take into account the health benefits that countries might get from various interventions. And that is an important part of progress. We need to find ways to promote not only longevity but also better quality of life when people get older.

There’s been a lot of focus on the ACA and its short-term implications. We are the only center that I know of that is actually thinking about how will this affect innovation in the long-term.

Q: What are you most looking forward to hearing about at “California: Uniting Science and Policy to Advance Cancer Care” on Thursday?

A: I’m looking forward to “The State of Cancer Research in the Golden State” and “Improving Access to Advanced Treatment” panels.

I think it is important we promote access to therapy and we do not end up with a world where we have large disparities in access because only the wealthy can get access to these therapies. At the same time, we have to make sure we can reimburse them appropriately.